| NPI | 1790262863 |
|---|---|
| Former Name | ANGELIA HENDERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1710I1003X Military Health Care Provider Independent Duty Medical Technicians |
| Enumeration Date | 2018-07-23 |
| Last Update Date | 2022-06-01 |